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It is reported that 20% of cardiac myxomas are located in the right atrium. An 81-year-old man presented with dyspnea, general fatigue and leg edema lasting for a year. Echocardiography revealed an 80 mm tumor occupying the right atrium and the right ventricle. At surgery, the tumor attached to the atrial septum was removed with the surrounding septal wall. As the tricuspid annulus was dilated, tricuspid annuloplasty with an artificial ring was also carried out. After coming off cardiopulmonary bypass, the patient developed pulmonary hypertension with the pulmonary arterial pressure being 80% of the systemic pressure, which subsided gradually day by day. Histopathological diagnosis was cardiac myxoma. Postoperative lung perfusion scintigraphy revealed postoperative multiple defects. It was considered that multiple tumor embolisms in the distal pulmonary artery caused postoperative pulmonary hypertension. Careful follow-up for remote recurrence would be essential.

Trisomy 13 is associated with a variety of congenital anomalies, some of which are life-threatening and related to poor prognosis. Therefore, cardiac surgery is rarely offered to these patients, especially to those with complex cardiac anomalies. We report the case of a neonate weighing 2324 g who was born with severe congenital heart defects. Transthoracic echocardiography revealed the diagnoses of asplenia, single ventricle, aortic stenosis, coarctation of the aorta, hypoplastic aortic arch, and total anomalous pulmonary venous return. She was hemodynamically unstable. Palliative Norwood procedure with right ventricle-pulmonary artery conduit (RV-PA conduit) was performed at the age of 1 day to save her life. On postoperative day 7, chromosome analysis revealed trisomy 13. Echocardiography revealed good heart function; stable hemodynamic status was achieved with minimal amounts of inotropic agents. However, she developed anuria, which did not improve despite situational possible interventions, including peritoneal dialysis and continuous hemodiafiltration. On postoperative day 37, she succumbed to sudden cardiorespiratory failure. Nevertheless, this case indicates that a neonate with trisomy 13 can have a better chance at survival with cardiac surgery such as the Norwood procedure with an RV-PA conduit.

The low arterial oxygen saturation (SaO2) after bidirectional cavopulmonary shunt (BCPS) predicts poor prognosis. The venous oxygen saturation of inferior vena cava (SivcO2), as well as the pulmonary blood flow/systemic blood flow ratio (Q p/Q s) affects the SaO2. The purpose of this study is to determine whether SivcO2 or Q p/Q s should be increased to achieve better outcomes after BCPS. Forty-eight patients undergoing BCPS were included. Data of patients' age and body weight, SivcO2, Q p/Q s, pulmonary artery (PA) pressure and resistance, PA area index, morphology of ventricle, atrioventricular valve regurgitation, and history of PA plasty were collected. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the SaO2 after BCPS. There was a significant correlation between SivcO2 and SaO2 (r = 0.771, P < 0.00001). There was no strong correlation between Q p/Q s and SaO2 (r = 0.358, P < 0.05). Stepwise multiple logistic regression analyses revealed that both SivcO2 (r = 0.49, 95 % confidence interval (CI) 0.37-0.62, P < 0.0001) and Q p/Q s (r = 11.1, 95 % CI 3.3-18.9, P = 0.007) most affected SaO2 after BCPS. Since the SivcO2 has a stronger correlation than Q p/Q s with SaO2, despite the fact that both raising Q p/Q s and raising cardiac output can increase SaO2, raising cardiac output should be considered prior to Q p/Q s to raise the SaO2 after BCPS.

In pediatric cardiac surgery, informed consent is often obtained from the patient's parents. The parents are commonly under great stress due to being in a situation where they have to make the important decision of whether their child will undergo cardiac surgery. Cardiac surgery does not necessarily determine the patient's prognosis if he or she has other organ anomalies or systemic diseases. In such cases, communication among the cardiac surgeon, pediatrician, and family becomes even more crucial. In pediatric cardiac surgery, it is important to obtain informed consent with adequate explanations, an understanding of the parents' stressful situation, and knowledge of the patient's background. In this article, we introduce two examples of obtaining informed consent for two common pediatric cardiac operations, atrial septal defect closure and ventricular septal defect closure.

Recently, due to the progress in patient managements with antibiotics, the prognosis of the active phase infectious endocarditis (IE) has improved, but in some cases, urgent or emergent surgical treatment is inevitable because of the uncontrollable acute heart failure due to valve regurgitation, uncontrollable infection with circulatory collapse, or high embolization risk. We reviewed the outcomes of the 57 IE patients who underwent surgical treatment in our hospital from January, 2000 to April, 2012. Preoperative state including inflammatory responses, bacterial blood culture, antibiotic administration, and surgical procedures were examined. No statistical significances were detected in the mortalities between elective cases (n=43)and urgent or emergent cases (n=14). Totally, mortality was 5.3% including one case in prosthetic valve endocarditis, and was satisfactory.

Minimally invasive cardiac surgery has been performed for patients with patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD). Video-assisted thoracoscopic interruption of PDA (VAT-SPDA) is effective for infants and neonates, especially for low birth weight babies. On the other hand, catheter intervention using PDA and ASD occluder devices have been widely used in our country. However, serious complications were reported in some papers. Recently, the device occlude has been applied to VSD. In percutaneous approach, there have been serious complications such as aortic regurgitation and complete atrioventricular block. The transatrial and perventricular approach are now advocated to avoid these complications. These approaches are called "hybrid approach", which is achieved with collaboration between catherter interventionists and cardiac surgeons. In the future, the hybrid approach including stent graft insertion and transaortic valve implantation would be important alternative procedure in both adult and pediatric cardiovascular surgery.

The linezolid treatment for methicillin-resistant Staphylococcus aureus (MRSA) infection was sporadically reported in children. Here we describe a case of a 6 month-old patient underwent mediastinal drainage and artificial conduit removement caused by MRSA infection. After that, linezolid treatment was started and bacteremia was resolved after 14 days of treatment. At discharge, he was no febrile, his blood culture were sterile. We report a case of a patient with MRSA endocarditis treatment with linezolid.

The authors performed a complete repair for a total defect type aortopulmonary window (APW) in an extremely low birth weight neonate weighing 1.1 kg. The APW was repaired using an autologous pericardial patch. A novel cardiopulmonary bypass system with low priming volume allowed a safe surgery for the premature patient.

Over the past decade, video-assisted thoracoscopic techniques have been used in the pediatric population. Recently, the computer-enhanced robotic system has been applied to video-assisted thoracoscopic interruption of patent ductus arteriosus (VATS-PDA). We focused on the utility of a voice-controlled robotic arm (automated endoscope system for optimal positioning: AESOP 3000) in VATS-PDA. Thirteen infants weighing 4.2 approximately 12.6 (mean 6.6) kg underwent robotically assisted VATS-PDA. Robotically assisted VATS-PDA is comparable with closure by means of the conventional video-assisted thoracoscopic technique.

Objective: Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window." We analyzed the factors limiting this approach to determine the best factor predicting risk., Methods: Of 26 patients who had an ASD or a VSD, 14 underwent complete repair using a transxiphoid approach. Preoperative data collected for all patients included the relationship between the right ventricular outflow tract and the lower sternum (the RVSA) in the cineangiograph. Multiple logistic regression analysis was used to investigate which of the factors best predicted whether the transxiphoid approach should be adopted., Results: The factors best predicting this approach were the combination of RVSA and body surface area (BSA) (odds ratios of 2.982 [P = .018] and 0.925 [P = .046], respectively). With the logistic model used in a prospective study of 6 consecutive patients, we were completely successful in predicting whether the transxiphoid approach could be performed., Conclusion: The combination of RVSA and BSA was the limiting factor for using the transxiphoid approach in congenital cardiac surgery.

Background: Historically the Fontan operation in patients with single ventricle asplenia syndrome has been associated with high mortality. We studied whether recent modifications of the surgical technique have improved outcome., Methods: A retrospective review of 11 patients with asplenia syndrome who underwent a Fontan operation between 1996 and 2002 was performed., Results: Anomalies of pulmonary venous return included 5 patients (46%) and 4 patients with an isolated hepatic venous return from inferior vena cava (36%). The type of Fontan procedure included 6 patients with an extracardiac tube-graft, 3 with a lateral tunnel modification, 1 with an intra-atrial tube graft, and 1 with an intra-extra atrial tube graft. A fenestration was placed in 3 patients (27%). There were no early deaths and 2 late hospital deaths (18%) due to tachyarrythmia and failed Fontan circulation. There were no late deaths and no complications during follow-up periods (mean 3 years). Of 21 patients diagnosed with asplenia syndrome between 1990 and 2000, overall survival was 57% and 12 patients underwent a Fontan-type operation., Conclusions: The Fontan operation can now be performed in patients with asplenia syndrome with good survival. Fontan staging, appropriate choice of Fontan modification, aggressive treatment of concomitant malformations, and use of a fenestration contribute to improved outcome.

Background: A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence of the bidirectional cavopulmonary shunt alone to secure pulmonary blood flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt in patients who do not meet the criteria for the Fontan operation., Methods: Eleven patients who underwent PBCPS between 1989 and 1993 were reviewed. We compared the results of cardiac catheterization immediately before PBCPS and during the postoperative observation period (310 +/- 257 days)., Results: Pulmonary blood flow and arterial oxygen saturation increased significantly after PBCPS (p = 0.01). Pumonary artery area index showed a tendency to increase (p = 0.11). The mean number of risk factors for the Fontan procedure decreased significantly from 1.8 +/- 1.1 to 0.7 +/- 0.8 after PBCPS (p < 0.05). Overall, 5 of the 11 patients (45.5%) met the criteria for the Fontan procedure, and a fenestrated Fontan procedure was carried out in 4 of them., Conclusions: The PBCPS is useful for high-risk Fontan patients not only in the staged Fontan operation, but also as definitive palliation.